rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2017-96-103rsp-2344Research ArticleОБЗОРREVIEWЛабораторные биомаркеры анкилозирующего спондилитаLABORATORY BIOMARKERS FOR ANKYLOSING SPONDYLITISАлександроваЕ. Н.AleksandrovaE. N.

Москва, Россия 115522 Москва, Каширское шоссе, 34А

Moscow, Russia 34A, Kashirskoe Shosse, Moscow 115522

aleksandrovaen2015@yandex.ruНовиковА. А.NovikovA. A.

Москва, Россия 115522 Москва, Каширское шоссе, 34А

Moscow, Russia 34A, Kashirskoe Shosse, Moscow 115522

ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian Federation20170803201755196103Copyright © Александрова Е.Н., Новиков А.А., 20172017Александрова Е.Н., Новиков А.А.Aleksandrova E.N., Novikov A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/2344

Анкилозирующий спондилит (АС) – хроническое воспалительное заболевание из группы спондилоартритов (СпА), характеризующееся поражением крестцово-подвздошных суставов и позвоночника с частым вовлечением в патологический процесс энтезисов и периферических суставов. Достижения современной лабораторной медицины способствовали существенному расширению спектра патогенетических, диагностических и прогностических биомаркеров АС. В настоящее время выделены ключевые патогенетические биомаркеры АС (терапевтические «мишени»), к которым относятся фактор некроза опухоли α (ФНОα), интерлейкин 17 (ИЛ17) и ИЛ23. Среди диагностических и прогностических лабораторных биомаркеров АС наибольшее значение в клинической практике имеют HLA-B27 (для ранней диагностики заболевания) и С-реактивный белок (СРБ; для оценки активности, риска рентгенологического прогрессирования и эффективности терапии). Новым биомаркером, позволяющим с высокой чувствительностью и специфичностью осуществлять диагностику аксиального СпА на ранней стадии, являются антитела к CD74. Ряд лабораторных биомаркеров, включая кальпротектин, матриксную металлопротеиназу 3 (ММП3), васкуло- эндотелиальный фактор роста, Dickkopf-1 (Dkk-1) и С-терминальный телопептид коллагена II типа (CTX II), недостаточно хорошо отражают активность заболевания, но могут быть предикторами прогрессирования структурных изменений позвоночника и крестцово-подвздошных сочленений при АС. Мониторинг уровня кальпротектина в крови позволяет эффективно прогнозировать ответ на терапию ингибиторами ФНОα и моноклональными антителами к ИЛ17А. Перспективы лабораторной диагностики АС связаны с клинической валидацией кандидатных биомаркеров в ходе больших проспективных когортных исследований и поиском новых протеомных, транскриптомных и геномных маркеров на основе инновационных молекулярно-клеточных технологий.

Ankylosing spondylitis (AS) is a chronic inflammatory disease from a group of spondyloarthritis (SpA), which is characterized by lesions of the sacroiliac joints and spine with the common involvement of entheses and peripheral joints in the pathological process. Advances in modern laboratory medicine have contributed to a substantial expansion of the range of pathogenetic, diagnostic, and prognostic biomarkers of AS. As of now, there are key pathogenetic biomarkers of AS (therapeutic targets), which include tumor necrosis factor-α (TNF-α), interleukin 17 (IL-17), and IL-23. Among the laboratory diagnostic and prognostic biomarkers, HLA-B27 and C-reactive protein are of the greatest value in clinical practice; the former for the early diagnosis of the disease and the latter for the assessment of disease activity, the risk of radiographic progression and the efficiency of therapy. Anti-CD74 antibodies are a new biomarker that has high sensitivity and specificity values in diagnosing axial SpA at an early stage. A number of laboratory biomarkers, including calprotectin, matrix metalloproteinase-3 (MMP-3), vascular endothelial growth factor, Dickkopf-1 (Dkk-1), and C-terminal telopeptide of type II collagen (CTX II) do not well reflect disease activity, but may predict progressive structural changes in the spine and sacroiliac joints in AS. Blood calprotectin level monitoring allows the effective prediction of a response to therapy with TNF inhibitors and anti-IL-17А monoclonal antibodies. The prospects for the laboratory diagnosis of AS are associated with the clinical validation of candidate biomarkers during large-scale prospective cohort studies and with a search for new proteomic, transcriptomic and genomic markers, by using innovative molecular and cellular technologies.

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The authors declare that there are no conflicts of interest present.